Comment: Stem-cell research? Surplus or not, it’s a matter of life and death for embryos

Sydney
4 August 2002

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Comment: Stem-cell research? Surplus or not, it’s a matter of life and death for embryos

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Comment: Stem-cell research? Surplus or not, it’s a matter of life and death for embryos

Federal MPs will be allowed a conscience vote on the embryo experimentation bill

As Federal MPs prepare to vote on the issue, Dr JOE SANTAMARIA calls for more consideration to be given to moral questions on the status of the embryo and on the ethical difference between using embryonic stem cells and adult stem cells in medical research.

Making ethical decisions

Over the past few weeks, I have received several letters from senior politicians. The contents are predictably similar, as if they were composed from a pro forma script.

I had sent each one of them a dossier of documents that addressed the question of the moral status of the embryo and the ethical difference between using embryonic stem cells and adult stem cells.

Each response acknowledged that the use of excess embryos for research purposes raised a “range of complex ethical, social and scientific considerations”.

I was informed that the matter had been resolved at a meeting of the Council of Australian Governments (COAG) between the Prime Minister and the Premiers of the various states and territories, on April 5, 2002.

The meeting had adopted “a national approach on human cloning, assisted reproductive technology (ART) and related matters.

“COAG has decided to allow embryos surplus to accredited ART programs to be used in research, subject to a number of conditions,” the letters said.

The members of COAG believed that this decision addressed the ethical concerns of those opposed to the use of embryonic stem cells as the surplus embryos were headed for statutory destruction and it was ethically acceptable to use them for an altruistic purpose that could benefit other members of the community.

About the time that I received these letters, I downloaded an article from the internet that was entitled Solving moral problems in Bioethics.

The author is Mons George Graham, a Doctor of Canon Law with a special interest in the process of decision making in bioethics.

In the article he traces the development of moral theology as a discipline of its own and gives a succinct account of the process of casuistry, which is the application of moral principles to specific situations (i.e. looking at cases).

He sees bioethics as an ‘orphan discipline’ which has split off from moral theology as bioethicists struggle to reach conclusions without reference to a final judgment or divine revelation.

In what is a very thoughtful and illuminating article, the author laments the modern development of “morality by committee”.

In many hospitals and medical centres, these committees are formed of people from many medical and nursing specialties, but also of lawyers, clergymen and non-professionals.

The decisions would be based on a majority vote, and the members of the committee may approach the case from different philosophical and theological standpoints.

When medical problems are approached with this type of ethics committee, it would not be unexpected to find that the decisions are contrary to traditional moral absolutes.

If the case involved an abortion, the absolute principle that human life could not be directly attacked might be overturned by the committee’s agreement that the financial or educational wishes of the mother would justify the abortion.

This morality by committee has become more common in the past 30 years.

Decisions on cases in bioethics have become disconnected from moral absolutes, and sentimentality has become directive … Those who defend this new laxity … describe “the old tradition of medical ethics as too frail to meet the ethical challenges posed by the new science and medicine”.

In the light of these comments by Mons Graham, the decision of the Council of Australian Governments on the experimental use of stem cells should come as no surprise.

I was informed by the politicians that the Prime Minister and his confreres had consulted widely in the community, including “researchers, ethicists and religious leaders”.

But in the end, it was a committee of non-ethicists who reached a political decision which “addressed the ethical concerns this sphere of research raises”.

As result of this decision, the Prime Minister, Mr John Howard, introduced a bill into the House of Representatives on June 29.

The bill will be debated in Parliament during August.

Ethical questions

This is a topsy-turvy way of resolving a moral or ethical problem.

In some respects, this is recognised by the politicians as it is proposed to introduce legislation that will allow embryo experimentation under regulated conditions and each member of the parliament will be allowed a conscience vote.

However there are two questions that must be answered first, according to moral principles and not subjective feelings.

The first question is: is it ever morally right to deliberately destroy an innocent human being?

The second question is: does the end you have in mind ever justify a morally evil way of achieving it?

Graham tackles the issue of conscience at some length. He comments that “the judgment of conscience confronts man with the law, not a mere ideal. When conscience judges the moral goodness or evil of a particular action, the judgment is made on the basis of the law, whether written in their hearts or revealed by God”.

Moreover, the judgment is applied to a specific concrete situation, in this instance to the deliberate destruction of human embryos for experimental purposes.

Whether they are surplus or not is irrelevant.

It is time therefore for some genuine casuistry.

It is interesting to note that when 80 Nobel laureates wrote to President Bush, urging him to fund research on embryonic stem cells, an American commentator drily remarked in the Washington Post: “Nobody ever said these Nobel Prizes are for ethics.”

Conflicting Opinions: Utilitarianism

It is true that the politicians have received conflicting ethical opinions, for modern bioethics has become discordant due to different schools of thought.

Many scientists, especially those working in the field of ART, pin their beliefs on the philosophy of Utilitarianism, as espoused by Peter Singer and Julian Savelescu who write prolifically and are much sought after to address scientific conferences.

They do not believe in moral absolutes and their concept of personhood is based on the possession of certain mental faculties, such as self-awareness, rationality and social communication.

Other bioethicists speak in a subjective way, claiming that if I feel it is good for me to do something, then there should be no moral stigma attached to my action.

This approach is closely identified with the concept of Relativism which simply means that each person should set his or her own moral values.

Christian tradition

Within the Christian tradition, quite apart from the Decalogue or other scriptural injunctions, moral theology is based on the concept of the dignity of the human person.

While books have been written about this concept, it invokes the premise that each human being has a special kind of nature which is shared with all other human beings.

Each human being has a beginning – when the human zygote is formed – and each will die a natural death.

Every human being has a destiny, a transcendent life beyond the dissolution of the physical body.

That life beyond the grave will be either happy or filled with grief, depending on how each one of us has behaved in this life in applying moral principles to concrete situations.

In other words, there will be a final judgment by a divine Creator.

This is a simplistic account of our destiny and it says nothing about the theology of Redemption.

It barely touches on the concept of the Natural Law in the Christian tradition. But what it does pose is the question of Ultimate Truth, of an objective Reality.

It says that we should act in a way that serves our ultimate happiness – the ultimate Good.

Tradition of rights

Over the last three millennia, a system of law has evolved as philosophers have sought to unravel human reality.

The Romans were the ones who codified their judicial judgments in AD533. The underlying philosophy of that legal code was adopted throughout the world.

Waldstein, an eminent Austrian lawyer, has pointed out that this code rests on an intuitive affirmation that “every man has inborn rights, evident to reason”.

In Section 5 of the Victorian Infertility Act, the first two principles are:

1. The welfare and interest of any person born or to be born as a result of a treatment procedure are paramount.

2. Human life should be preserved and protected.

When did I begin?

We all began our lives as a human zygote, the very first cell formed from the fertilisation of the ovum by a sperm. We were born because we were respected as human beings from our first moment as a human zygote.

We are alive today because those responsible for our care observed the principle that “human life should be preserved and protected”.

It is interesting that many parents of “laboratory embryos” are reluctant to relinquish their “surplus embryos” as if they know that they are relinquishing their begotten child.

While they may have little understanding of the ethical reasoning about the moral status of the embryo, they have an intuitive appreciation that their embryo is really their child.

The recent mix up in a British infertility clinic revealed in a startling way how precious the embryo is in the eyes of the parents, even when it is still in the laboratory.

However, once created in the laboratory, these embryos have nowhere to go if they are not put into the womb of an adult woman.

Such “surplus embryos” are then unable to achieve their full potential, not due to any inherent disability to do so but because they have been excluded from gaining access to the necessary environment for continued development.

Freezing such embryos therefore becomes a form of life support that is futile.

Defreezing them and allowing them to succumb to the natural process of an unanchored existence is a hard moral choice but it is not of the same order as to destroy them for a so-called altruistic purpose so that scientists can harvest the living inner cell mass.

It is the same principle that we apply to the withdrawal of futile burdensome treatment in the management of the terminally ill patient.

There is a great tendency by those who promote the use of embryonic stem cells to “wordsmith their arguments to make this issue less clear and more palatable to the unaware”.

So, too, do we find with the term “the pregnant state”.

We are told that a woman is pregnant when the blastocyst becomes established in the uterine cavity.

This leads us to believe that until that happens the woman is not pregnant and therefore the laboratory embryo has no special moral status until it is implanted.

Pregnancy means “being with child”.

This means that pregnancy begins from the moment that the child is conceived, which, in the natural order of events, occurs in the fallopian tube with the formation of the zygote.

The zygote is the first cell of our human existence.

Further cell divisions occur in the tube and, by the time the new human being reaches the uterus, the blastocyst stage has been reached.

The earliest stage of “being with child” is within the body of the mother but outside the womb.

Artificial reproduction has transferred the earliest stages of embryonic development to the laboratory.

Some reproductive technologists have exploited this artificial deviation by identifying the pregnant state, even in the natural order of human reproduction, as beginning with uterine attachment, thereby stripping the unattached embryo of any moral status.

But that is not so. For even the laboratory embryo is fully programmed to get on with its life.

Dr Joe Santamaria, OAM, MMed, foundation chairman of the Family Council of Victoria and the St Vincent’s Bioethics Centre, is a member of the Pontifical Academy for Life – Vatican City. He is a consultant physician.